Towards a Health Silk Road
Ladies and gentlemen
1. The romanticism surrounding the Silk Road is enduring, and its economic and historical significance is profound. But the term Silk Road has become somewhat of a misnomer, because it is neither about silk, nor is it a road.
2. The legend is that an Empress in ancient China had a silkworm cocoon drop into her tea from a mulberry tree. From there, she got to appreciate the fineness of the threads, which led to sericulture and export to, as well as trade with, the West. But as trade routes opened up, the exchanges included not just silk, but spices, tea, animals, precious metals, other forms of textiles, and manufactured products.
3. It was also not just a road, but an entire trade network spanning the western part of China, across the Pamirs, Central Asia, the Levant, Anatolia, and then Europe. If we include the idea of the Maritime Silk Road, it is even more vast, covering the various waterways in Southeast Asia, linking the ancient civilisations of China and India.
4. Ultimately, the Silk Road cannot be described in goods or geography. It is a powerful idea that is relevant until today.
5. First and foremost, the Silk Road is about technological advancement, and the sharing of knowhow. In the past, it might have been about sericulture, which originated from China, and then subsequently spread to Korea, Japan and India. Today, it represents all the technological breakthroughs in areas including digitisation, health sciences, and sustainability.
6. Scientists, with their curious nature, want to collaborate and advance humanity’s understanding of our world – that nature can be suppressed, but cannot be altered by politics.
7. Second, the Silk Road is about a thoroughfare of exchanges, of goods, people, ideas, and most significantly, cultures. Whether it is Kashgar, Dunhuang, Samarkand, Damascus, modern day Istanbul, or Singapore, we are multicultural in nature, with many layers of identities and histories. These are the nodes where cultures and civilisations intersect. Because of trade, these cities contain more of humanity than they were physically built for. In the course of history, when they were thriving with trade, they represented symbols and promises of peace and coexistence between different cultures.
8. Third, the Silk Road is about an outward-oriented mindset, that we bring greater good by collaborating and working with others beyond the world we know. We embrace the unknown, to understand and learn from others. And when we encounter something alien to us, we seek to appreciate, understand and over time, let it enrich our own identity.
9. The vision of a Health Silk Road should thus embody the same essence I have talked about: embracing technology, building a thoroughfare, and adopting an outward-oriented mindset.
10. On technology, we are already living in an era of advanced medical science with a global data infrastructure that connects people from all around the world. More can be done to advance medical science by promoting joint research efforts and collaboration.
11. More significantly, we are at the cusp of major breakthroughs in medical science, in novel treatments, such as genetic and cellular therapies. These therapies were the birthplace of the mRNA technology which was applied successfully to develop COVID-19 vaccines. When these therapies become successfully applied at scale to other diseases, such as cancer, it will usher in a whole new era of medicine, supported by very different economics and public policy.
12. Singapore has invested in this area in a targeted way. For example, the Lung Cancer Translational and Clinical Research (TCR) Flagship Programme saw 13 local clinical trials. We have also established regional clinical research networks for cell therapy in certain diseases. These include industry partnerships, formed by SingHealth Duke-NUS Cell Therapy Centre and SingHealth Duke-NUS Regenerative Medicine Institute of Singapore.
13. In this respect, I suggest we push for more regional clinical trials involving the populations of ASEAN and China. This will leverage the diverse population and genetic pools of our region, improve the robustness of the trials and expedite the development of treatments. This would be a relatively low hanging fruit, yet impactful initiative involving scientists agreeing on clinical trial protocols, so that data generated from regional trials is compliant for eventual dossier submission to regulatory authorities in both ASEAN countries and China.
14. To this end, Singapore has signed an MOU with Suzhou, China in December 2020 on biomedical collaborations with a focus on regulatory connectivity, and includes setting up a joint Biomedical Innovation Hub in Suzhou Industrial Park. We can expand such models.
15. Second, we need to build a thoroughfare of exchanges that goes beyond the nucleus of technology, and expand to trade, investment, people and regulatory cooperation. There are many opportunities for us to seize.
16. We are already seeing significant investments from biopharma companies flowing both ways between China and ASEAN. The industry clearly sees potential of this combined market. Governments can support this by creating the conducive investment conditions of stability, collaboration, and a sharp focus on good science.
17. With the worst of COVID-19 over, we should rekindle and promote the exchange of medical students and healthcare workers. The National University Heart Centre, Singapore, for example, has a long-standing arrangement to train cardiologists in China. Singapore also benefits from the presence of healthcare workers from China and various ASEAN countries, which augments our local healthcare workforce.
18. In the process of people exchanges and mutual learning, we can also do better in integrating Western medicine and Traditional Chinese Medicine, especially in preventive care. It is already a promising emerging model of aged care in China.
19. In addition, we can encourage more efficient information sharing amongst countries, especially data on infectious diseases, to effect robust evidence-based public health policies. We can streamline regulatory processes to expedite evaluation and approval of safe, cost-effective novel diagnostics and therapeutics. This can be an extensive, broad thoroughfare of collaboration and friendship.
20. Finally, adopt an outward-oriented mindset for the Silk Road of today is no longer constrained by the stamina of animals and the range of caravans. We live in a borderless world. We can cast our collaborative efforts beyond ASEAN and China to regions such as America, Europe and India. Our scientists already work within global networks, apprising each other of their findings through global publications.
21. During the COVID-19 pandemic, Singapore’s National Vaccination Programme comprises vaccines from the US, Europe and China, which is a key reason why we could achieve very broad vaccine coverage in our population.
22. Recently, the US National Academy of Medicine (NAM) based in Washington, D.C., launched their study report on healthy longevity in Singapore, a culmination of the effort of experts from all over the world. Further, the reason for them to do so is that East Asia is ageing rapidly and Singapore is one of the fastest ageing countries.
23. Ageing will drive up disease burden in all our societies, but the solution goes beyond healthcare. It is deeply cultural, because every society treats their aged differently. In some societies, older people gain social seniority, but in others, they lose some relevance. Some rely more on institutional care, while other cultures rely on family care.
24. Regardless of all these backdrops in a rapidly ageing society, we need to enable seniors to continue contributing by creating the social and physical infrastructure to enable them to live independently within communities with dignity. We can even redefine old age by taking a prospective rather than a retroactive viewpoint. Ageing is a global phenomenon, requiring a global diverse response.
25. It is my sincere hope that all countries embrace the spirit of the Silk Road to harness medical science and collaborate for the benefit of our people and humankind. By focusing on our common challenges as part of humanity, we can strengthen people to people ties, appreciate each other’s cultures to enrich our own and bring peace and happiness to our peoples.